Wide gap between breasts. What is the best implant choice? (Photo)

Question

I breastfed for 3 years and now want breast implants. My only fear is that they would end up looking weird since I have a very wide gap between my breast, also I want to go fairly big full c to d cup I went to a consultation and he suggested high profile 425cc. Opinions?

Scott W. Harris, MD, FACS · Answer

The amount of improvement in cleavage is a function of your anatomy and the size/type of implant you chose. While the implant must be centered on your nipples, this forces and limits the amount of improvement your PS can achieve. The implant size on the other hand has a direct effect on the cleavage improvement... the larger the implant, the more narrow the distance becomes between the breasts. I hope that helps!!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  The medial position of the implant is in part determined by the insertion point of your pectoralis muscle and the position of your nipple relative to the entire breast.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.  This entire surgery
can be performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Because of the naturally wider "footprint" of your breasts relative to your rib cage and breast bone you will have a wider gap between your breasts regardless of implant style or size.  Implant placement is limited to your natural anatomy - chest muscle insertion along lower ribs and sternum, width of breast bone, and amount of starting breast tissue.  Attempts to "cheat" the implants closer will increase your risk of synmastia (uniboob) and will cause your implants to point even further out to the sides.  See an ASPS board certified plastic surgeon to discuss your options and to select an implant based on dimensional analysis.

Donovan Rosas, MD · Answer

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. 
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum = greater separation of the breasts = less dramatic cleavage. This space can be narrowed (with some risk of symmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and mid-line migration of the implant (the dreaded "uni-boob").
Based upon your photos, you appear to be a reasonable candidate for augmentation. A submuscular augmentation may accentuate the wide set nature of your breasts. With that in mind, you may opt for subglandular placement (which will allow for a medial placement). However, one must understand that purposely forcing the implant centrally will not allow for it to be centered on your breast mound.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear mhka12,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Anthony Barabas, MBBS, FRCS (Plast) · Answer

Thanks for your question. With a wide gap before surgery, you are still likely to have a wider gap than most people after surgery. This can be corrected to a certain extent. Firstly if you have happy for your nipples not to sit in the centre of the implants (an implant is usually centred behind the nipples) and that the nipples point slightly out to the sides, then the implants can be placed more centrally. Implants under the muscles are restricted medially by the muscles insertion onto your sternum, so implants under your breasts mean they can be place more centrally, but at the risk of the implant edge being visible. Wider implants mean the implant can fill out the breast centrally (medially) and over the flanks, but with round implants this also means they will sit higher and lower on the chest wall. There are more options available with anatomical implants.

Steven Wallach, MD · Answer

You are limited in many ways by your anatomy. If you have wide cleavage, them you will likely have wide cleavage after surgery.

Jack Peterson, MD · Answer

With a wide gap spacing, the decision is really more about placement and pocket formation. Visit with your board certified plastic surgeon to discuss.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. You are correct: every patient undergoing breast augmentation surgery should understand that their anatomic starting point will limit the outcome of breast augmentation surgery.   In your case specifically, your anatomic starting point will to some degree determine how much space will be present between your breasts after breast augmentation surgery.  Other factors involved include careful breast implant pocket dissection and careful selection of breast implant size/profile.  Remember (when it comes to breast implant pocket dissection and achievement of ideal breast implant cleavage) that each nipple/areola complex must be centered on each breast mound.
Ultimately,  careful selection of plastic surgeon, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "full C to D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

Wide gap between breasts. What is the best implant choice? (Photo)

Answers (9)

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